Laparoscopic-assisted distal ventriculoperitoneal shunt placement.
BACKGROUND
Intraperitoneal adhesions, obesity, and distorted abdominal anatomy in shunt-dependent hydrocephalic patients are patient characteristics that increase distal ventriculoperitoneal (VP) shunt failure rates. The use of laparoscopic-aided placement of the distal VP catheter as a technique to decrease the failure rate is evaluated in these patients.


METHODS
Thirteen hydrocephalus patients considered to either have intra-abdominal adhesions, be obese, or have distorted abdominal anatomy underwent laparoscopic-aided distal VP catheter placement or revision. Two had shunts placed for the first time and eleven had revisions. Eight patients had revisions performed by both the standard minilaparotomy and laparoscopic methods, but at different times. The average surgical times for both techniques were looked at for these eight patients. Case illustrations are presented.


RESULTS
In patients who had both types of abdominal approaches, the average surgical time was 81 min for the laparoscopic-aided technique versus 116 min for the minilaparotomy procedure. The only complication related directly to the laparoscopic procedure was one wound infection.


CONCLUSIONS
In patients with intra-abdominal adhesions, obesity, or distorted abdominal anatomy, laparoscopic-aided distal shunt insertion increases the success rate by its direct visual capability and the ability to lyse abdominal adhesions and position the distal end of the catheter in a desired place.
Khosrovi
H
H
Department of Neurosurgery, West Virginia University, Morgantown 26506, USA.
Kaufman
H H
HH
Hrabovsky
E
E
Bloomfield
S M
SM
Prabhu
V
V
el-Kadi
H A
HA
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D005260:Female; D006801:Humans; D006849:Hydrocephalus / Q000601:surgery*; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D017287:Ventriculoperitoneal Shunt / Q000379:methods*